Social inequalities in self-rated health by age: Cross-sectional study of 22 457 middle-aged men and women

BACKGROUND: We investigate the association between occupational social class and self-rated health (SRH) at different ages in men and women. METHODS: Cross sectional population study of 22,457 men and women aged 39-79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993-1997. The relationship between self-rated health and social class was examined using logistic regression, with a poor or moderate rating as the outcome. RESULTS: The prevalence of poor or moderate (lower) self-rated health increased with increasing age in both men and women. There was a strong social class gradient: in manual classes, men and women under 50 years of age had a prevalence of lower self-rated health similar to that seen in men and women in non-manual social classes over 70 years old. Even after adjustment for age, educational status, and lifestyle factors (body mass index (BMI), smoking, physical activity and alcohol consumption) there was still strong evidence of a social gradient in self-rated health, with unskilled men and women approximately twice as likely to report lower self-rated health as professionals (OR(men) = 2.44 (95%CI 1.69, 3.50); OR(women) = 1.97 (95%CI 1.45, 2.68). CONCLUSION: There was a strong gradient of decreased SRH with age in both men and women. We found a strong cross-sectional association between SRH and social class, which was independent of education and major health related behaviors. The social class differential in SRH was similar with age. Prospective studies to confirm this association should explore social and emotional as well as physical pathways to inequalities in self reported health.